1
|
Huneke NTM, Amin J, Baldwin DS, Bellato A, Brandt V, Chamberlain SR, Correll CU, Eudave L, Garner M, Gosling CJ, Hill CM, Hou R, Howes OD, Ioannidis K, Köhler-Forsberg O, Marzulli L, Reed C, Sinclair JMA, Singh S, Solmi M, Cortese S. Placebo effects in randomized trials of pharmacological and neurostimulation interventions for mental disorders: An umbrella review. Mol Psychiatry 2024:10.1038/s41380-024-02638-x. [PMID: 38914807 DOI: 10.1038/s41380-024-02638-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024]
Abstract
There is a growing literature exploring the placebo response within specific mental disorders, but no overarching quantitative synthesis of this research has analyzed evidence across mental disorders. We carried out an umbrella review of meta-analyses of randomized controlled trials (RCTs) of biological treatments (pharmacotherapy or neurostimulation) for mental disorders. We explored whether placebo effect size differs across distinct disorders, and the correlates of increased placebo effects. Based on a pre-registered protocol, we searched Medline, PsycInfo, EMBASE, and Web of Knowledge up to 23.10.2022 for systematic reviews and/or meta-analyses reporting placebo effect sizes in psychopharmacological or neurostimulation RCTs. Twenty meta-analyses, summarising 1,691 RCTs involving 261,730 patients, were included. Placebo effect size varied, and was large in alcohol use disorder (g = 0.90, 95% CI [0.70, 1.09]), depression (g = 1.10, 95% CI [1.06, 1.15]), restless legs syndrome (g = 1.41, 95% CI [1.25, 1.56]), and generalized anxiety disorder (d = 1.85, 95% CI [1.61, 2.09]). Placebo effect size was small-to-medium in obsessive-compulsive disorder (d = 0.32, 95% CI [0.22, 0.41]), primary insomnia (g = 0.35, 95% CI [0.28, 0.42]), and schizophrenia spectrum disorders (standardized mean change = 0.33, 95% CI [0.22, 0.44]). Correlates of larger placebo response in multiple mental disorders included later publication year (opposite finding for ADHD), younger age, more trial sites, larger sample size, increased baseline severity, and larger active treatment effect size. Most (18 of 20) meta-analyses were judged 'low' quality as per AMSTAR-2. Placebo effect sizes varied substantially across mental disorders. Future research should explore the sources of this variation. We identified important gaps in the literature, with no eligible systematic reviews/meta-analyses of placebo response in stress-related disorders, eating disorders, behavioural addictions, or bipolar mania.
Collapse
Affiliation(s)
- Nathan T M Huneke
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
- Southern Health NHS Foundation Trust, Southampton, UK.
| | - Jay Amin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
- University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Alessio Bellato
- School of Psychology, University of Nottingham Malaysia, Semenyih, Malaysia
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Valerie Brandt
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Samuel R Chamberlain
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Luis Eudave
- Faculty of Education and Psychology, University of Navarra, Pamplona, Spain
| | - Matthew Garner
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Corentin J Gosling
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Université Paris Nanterre, DysCo Lab, F-92000, Nanterre, France
- Université de Paris, Laboratoire de Psychopathologie et Processus de Santé, F-92100, Boulogne-Billancourt, France
| | - Catherine M Hill
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Sleep Medicine, Southampton Children's Hospital, Southampton, UK
| | - Ruihua Hou
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- H Lundbeck A/s, Iveco House, Watford, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, UK
| | - Konstantinos Ioannidis
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Ole Köhler-Forsberg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
| | - Lucia Marzulli
- Department of Translational Biomedicine and Neuroscience (DIBRAIN), University of Studies of Bari "Aldo Moro", Bari, Italy
| | - Claire Reed
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Julia M A Sinclair
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Satneet Singh
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Marco Solmi
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Samuele Cortese
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University "Aldo Moro", Bari, Italy
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
| |
Collapse
|
2
|
Seymour J, Mathers N. Placebo stimulates neuroplasticity in depression: implications for clinical practice and research. Front Psychiatry 2024; 14:1301143. [PMID: 38268561 PMCID: PMC10806142 DOI: 10.3389/fpsyt.2023.1301143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024] Open
Abstract
Neither psychological nor neuroscientific investigations have been able to fully explain the paradox that placebo is designed to be inert in randomized controlled trials (RCTs), yet appears to be effective in evaluations of clinical interventions in all fields of medicine and alternative medicine. This article develops the Neuroplasticity Placebo Theory, which posits that neuroplasticity in fronto-limbic areas is the unifying factor in placebo response (seen in RCTs) and placebo effect (seen in clinical interventions) where it is not intended to be inert. Depression is the disorder that has the highest placebo response of any medical condition and has the greatest potential for understanding how placebos work: recent developments in understanding of the pathophysiology of depression suggest that fronto-limbic areas are sensitized in depression which is associated with a particularly strong placebo phenomenon. An innovative linkage is made between diverse areas of the psychology and the translational psychiatry literature to provide supportive evidence for the Neuroplasticity Placebo Theory. This is underpinned by neuro-radiological evidence of fronto-limbic change in the placebo arm of antidepressant trials. If placebo stimulates neuroplasticity in fronto-limbic areas in conditions other than depression - and results in a partially active treatment in other areas of medicine - there are far reaching consequences for the day-to-day use of placebo in clinical practice, the future design of RCTs in all clinical conditions, and existing unwarranted assertions about the efficacy of antidepressant medications. If fronto-limbic neuroplasticity is the common denominator in designating placebo as a partially active treatment, the terms placebo effect and placebo response should be replaced by the single term "placebo treatment."
Collapse
Affiliation(s)
- Jeremy Seymour
- Retired Consultant Psychiatrist, Rotherham Doncaster and South Humber NHS Trust, Rotherham, United Kingdom
| | - Nigel Mathers
- Emeritus Professor, Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
| |
Collapse
|
3
|
Osumi M, Sumitani M, Iwatsuki K, Hoshiyama M, Imai R, Morioka S, Hirata H. Resting-state Electroencephalography Microstates Correlate with Pain Intensity in Patients with Complex Regional Pain Syndrome. Clin EEG Neurosci 2024; 55:121-129. [PMID: 37844609 DOI: 10.1177/15500594231204174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Objective: Severe pain and other symptoms in complex regional pain syndrome (CRPS), such as allodynia and hyperalgesia, are associated with abnormal resting-state brain network activity. No studies to date have examined resting-state brain networks in CRPS patients using electroencephalography (EEG), which can clarify the temporal dynamics of brain networks. Methods: We conducted microstate analysis using resting-state EEG signals to prospectively reveal direct correlations with pain intensity in CRPS patients (n = 17). Five microstate topographies were fitted back to individual CRPS patients' EEG data, and temporal microstate measures were subsequently calculated. Results: Our results revealed five distinct microstates, termed microstates A to E, from resting EEG data in patients with CRPS. Microstates C, D and E were significantly correlated with pain intensity before pain treatment. Particularly, microstates D and E were significantly improved together with pain alleviation after pain treatment. As microstates D and E in the present study have previously been related to attentional networks and the default mode network, improvement in these networks might be related to pain relief in CRPS patients. Conclusions: The functional alterations of these brain networks affected the pain intensity of CRPS patients. Therefore, EEG microstate analyses may be used to identify surrogate markers for pain intensity.
Collapse
Affiliation(s)
- Michihiro Osumi
- Graduate School of Health Science, Kio University. 4-2-2 Umaminaka, Kitakatsuragigun, Nara, Japan
- Neurorehabilitation Research Center, Kio University. 4-2-2 Umaminaka, Kitakatsuragigun, Nara, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital. 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Katsuyuki Iwatsuki
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan
| | - Minoru Hoshiyama
- Department of Health Sciences, Faculty of Medicine, Nagoya University, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi, Japan
| | - Ryota Imai
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka, Osaka, Japan
| | - Shu Morioka
- Graduate School of Health Science, Kio University. 4-2-2 Umaminaka, Kitakatsuragigun, Nara, Japan
- Neurorehabilitation Research Center, Kio University. 4-2-2 Umaminaka, Kitakatsuragigun, Nara, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan
| |
Collapse
|
4
|
Rengasamy M, Mathew S, Howland R, Griffo A, Panny B, Price R. Neural connectivity moderators and mechanisms of ketamine treatment among treatment-resistant depressed patients: a randomized controlled trial. EBioMedicine 2024; 99:104902. [PMID: 38141395 PMCID: PMC10788398 DOI: 10.1016/j.ebiom.2023.104902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Intravenous (IV) ketamine has emerged as a rapid and effective treatment for TRD. However, the specific neural mechanisms of ketamine's effects in humans remains unclear. Although neuroplasticity is implicated as a mechanism of action in animal models, relatively few randomized controlled trials (RCTs) in TRD patients have examined ketamine's impact on functional connectivity, a posited functional marker of neuroplasticity-particularly in the context of a mood-induction paradigm (termed miFC). METHODS 152 adults with TRD (63% female; 37% male) were randomly allocated to receive a single infusion of ketamine or saline in a 2:1 ratio. We examined changes in connectivity (from baseline to 24-h post-infusion) that differed by treatment, and whether clinical treatment response at 24-h post-infusion was uniquely related (among patients allocated to ketamine relative to saline) to (1) pre-treatment connectivity and (2) changes in connectivity. We examined both miFC and rsFC, using prefrontal cortex and limbic seed regions. We also conducted a multiverse analysis to examine findings most robust against analytic decisions. FINDINGS Across both miFC and rsFC, ketamine was associated with greater in prefrontal/limbic connectivity compared to saline, and lower baseline connectivity of limbic and prefrontal regions predicted greater treatment response in patients receiving ketamine. Greater connectivity increases in participants receiving ketamine was uniquely related to greater treatment response. In addition, certain findings were identified as being reproducible against different analytic decisions in multiverse analyses. INTERPRETATION Our findings identify specific neural connectivity patterns impacted by ketamine and were uniquely related to outcomes following ketamine (relative to saline). These findings generally support prominent neuroplasticity models of ketamine's therapeutic efficacy. These findings lay new groundwork for understanding how to enhance and optimize ketamine treatments and develop novel rapid-acting treatments for depression. FUNDING This research was supported by NIH grant R01MH113857 and by the Clinical and Translational Sciences Institute at the University of Pittsburgh (UL1-TR-001857).
Collapse
Affiliation(s)
- Manivel Rengasamy
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Sanjay Mathew
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Michael E. Debakey VA Medical Center, Houston, TX, USA; The Menninger Clinic, Houston, TX, USA
| | - Robert Howland
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Angela Griffo
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Benjamin Panny
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rebecca Price
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
5
|
Berkovitch L, Lee K, Ji JL, Helmer M, Rahmati M, Demšar J, Kraljič A, Matkovič A, Tamayo Z, Murray JD, Repovš G, Krystal JH, Martin WJ, Fonteneau C, Anticevic A. A common symptom geometry of mood improvement under sertraline and placebo associated with distinct neural patterns. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.15.23300019. [PMID: 38168378 PMCID: PMC10760263 DOI: 10.1101/2023.12.15.23300019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Importance Understanding the mechanisms of major depressive disorder (MDD) improvement is a key challenge to determine effective personalized treatments. Objective To perform a secondary analysis quantifying neural-to-symptom relationships in MDD as a function of antidepressant treatment. Design Double blind randomized controlled trial. Setting Multicenter. Participants Patients with early onset recurrent depression from the public Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) study. Interventions Either sertraline or placebo during 8 weeks (stage 1), and according to response a second line of treatment for 8 additional weeks (stage 2). Main Outcomes and Measures To identify a data-driven pattern of symptom variations during these two stages, we performed a Principal Component Analysis (PCA) on the variations of individual items of four clinical scales measuring depression, anxiety, suicidal ideas and manic-like symptoms, resulting in a univariate measure of clinical improvement. We then investigated how initial clinical and neural factors predicted this measure during stage 1. To do so, we extracted resting-state global brain connectivity (GBC) at baseline at the individual level using a whole-brain functional network parcellation. In turn, we computed a linear model for each brain parcel with individual data-driven clinical improvement scores during stage 1 for each group. Results 192 patients (127 women), age 37.7 years old (standard deviation: 13.5), were included. The first PC (PC1) capturing 20% of clinical variation was similar across treatment groups at stage 1 and stage 2, suggesting a reproducible pattern of symptom improvement. PC1 patients' scores significantly differed according to treatment during stage 1, whereas no difference of response was evidenced between groups with the Clinical Global Impressions (CGI). Baseline GBC correlated to stage 1 PC1 scores in the sertraline, but not in the placebo group. Conclusions and Relevance Using data-driven reduction of symptoms scales, we identified a common profile of symptom improvement across placebo and sertraline. However, the neural patterns of baseline that mapped onto symptom improvement distinguished between treatment and placebo. Our results underscore that mapping from data-driven symptom improvement onto neural circuits is vital to detect treatment-responsive neural profiles that may aid in optimal patient selection for future trials.
Collapse
Affiliation(s)
- Lucie Berkovitch
- Department of Psychiatry, Neuroscience, and Psychology, Yale University School of Medicine, New Haven, CT, USA
- Division of Neurocognition, Neurocomputation, Neurogenetics (N3), Yale University School of Medicine, New Haven, Connecticut, USA
- Université Paris Cité, Paris, France
- Department of Psychiatry, GHU Paris Psychiatrie et Neurosciences, Service Hospitalo-Universitaire, Paris, France
- Unicog, Saclay CEA Centre, Neurospin, Gif-Sur-Yvette Cedex, France
| | - Kangjoo Lee
- Department of Psychiatry, Neuroscience, and Psychology, Yale University School of Medicine, New Haven, CT, USA
- Division of Neurocognition, Neurocomputation, Neurogenetics (N3), Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jie Lisa Ji
- Manifest Technologies, Inc. New Haven, CT, USA
| | | | | | - Jure Demšar
- Department of Psychology, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia
| | - Aleksij Kraljič
- Department of Psychology, University of Ljubljana, Ljubljana, Slovenia
| | - Andraž Matkovič
- Department of Psychology, University of Ljubljana, Ljubljana, Slovenia
| | - Zailyn Tamayo
- Department of Psychiatry, Neuroscience, and Psychology, Yale University School of Medicine, New Haven, CT, USA
- Division of Neurocognition, Neurocomputation, Neurogenetics (N3), Yale University School of Medicine, New Haven, Connecticut, USA
| | - John D Murray
- Department of Psychological and Brain Science, Dartmouth College, Hanover, NH, USA
| | - Grega Repovš
- Department of Psychology, University of Ljubljana, Ljubljana, Slovenia
| | - John H Krystal
- Department of Psychiatry, Neuroscience, and Psychology, Yale University School of Medicine, New Haven, CT, USA
- Division of Neurocognition, Neurocomputation, Neurogenetics (N3), Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Clara Fonteneau
- Department of Psychiatry, Neuroscience, and Psychology, Yale University School of Medicine, New Haven, CT, USA
- Division of Neurocognition, Neurocomputation, Neurogenetics (N3), Yale University School of Medicine, New Haven, Connecticut, USA
| | - Alan Anticevic
- Department of Psychiatry, Neuroscience, and Psychology, Yale University School of Medicine, New Haven, CT, USA
- Division of Neurocognition, Neurocomputation, Neurogenetics (N3), Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Psychology, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
6
|
Frisaldi E, Shaibani A, Benedetti F, Pagnini F. Placebo and nocebo effects and mechanisms associated with pharmacological interventions: an umbrella review. BMJ Open 2023; 13:e077243. [PMID: 37848293 PMCID: PMC10582987 DOI: 10.1136/bmjopen-2023-077243] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVES This review aimed to summarise the existing knowledge about placebo and nocebo effects associated with pharmacological interventions and their mechanisms. DESIGN Umbrella review, adopting the Assessment of Multiple Systematic Reviews 2 tool for critical appraisal. DATA SOURCES MEDLINE/PubMed, Scopus, Web of Science, PsycINFO, Cochrane Central Register of Controlled Trial were searched in September 2022, without any time restriction, for systematic reviews, narrative reviews, original articles. Results were summarised through narrative synthesis, tables, 95% CI. OUTCOME MEASURES Mechanisms underlying placebo/nocebo effects and/or their effect sizes. RESULTS The databases search identified 372 studies, for a total of 158 312 participants, comprising 41 systematic reviews, 312 narrative reviews and 19 original articles. Seventy-three per cent of the examined systematic reviews were of high quality.Our findings revealed that mechanisms underlying placebo and/or nocebo effects have been characterised, at least in part, for: pain, non-noxious somatic sensation, Parkinson's disease, migraine, sleep disorders, intellectual disability, depression, anxiety, dementia, addiction, gynaecological disorders, attention-deficit hyperactivity disorder, immune and endocrine systems, cardiovascular and respiratory systems, gastrointestinal disorders, skin diseases, influenza and related vaccines, oncology, obesity, physical and cognitive performance. Their magnitude ranged from 0.08 to 2.01 (95% CI 0.37 to 0.89) for placebo effects and from 0.32 to 0.90 (95% CI 0.24 to 1.00) for nocebo effects. CONCLUSIONS This study provides a valuable tool for clinicians and researchers, identifying both results ready for clinical practice and gaps to address in the near future. FUNDING Università Cattolica del Sacro Cuore, Milan, Italy with the 'Finanziamento Ponte 2022' grant. PROSPERO REGISTRATION NUMBER CRD42023392281.
Collapse
Affiliation(s)
- Elisa Frisaldi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Aziz Shaibani
- Muscle and Nerve Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Fabrizio Benedetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| |
Collapse
|
7
|
Cheng CM, Li CT, Jeng JS, Chang WH, Lin WC, Chen MH, Bai YM, Tsai SJ, Su TP. Antidepressant effects of prolonged intermittent theta-burst stimulation monotherapy at the bilateral dorsomedial prefrontal cortex for medication and standard transcranial magnetic stimulation-resistant major depression: a three arm, randomized, double blind, sham-controlled pilot study. Eur Arch Psychiatry Clin Neurosci 2023; 273:1433-1442. [PMID: 36484844 PMCID: PMC9735131 DOI: 10.1007/s00406-022-01523-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022]
Abstract
The dorsomedial prefrontal cortex (DMPFC) plays a pivotal role in depression and anxiosomatic symptom modulation. However, DMPFC stimulation using a double-cone coil has demonstrated inconsistent results for antidepressant efficacy. No study thus far has investigated the antidepressant and anti-anxiosomatic effects of prolonged intermittent theta-burst stimulation (piTBS) bilaterally over DMPFC. Furthermore, head-to-head comparisons of antidepressant effects between standard iTBS and piTBS warrant investigation. This double-blind, randomized, sham-controlled trial recruited 34 patients with highly treatment-resistant depression (TRD) unresponsive to antidepressants and standard repetitive transcranial magnetic stimulation (rTMS)/piTBS. These patients were randomly assigned to one of three monotherapy groups (standard iTBS, piTBS, or sham), with treatment administered bilaterally over the DMPFC twice per day for 3 weeks. The primary outcome was the overall changes of 17-item Hamilton Depression Rating Scale (HDRS-17) over 3-weeks intervention. The changes in Depression and Somatic Symptoms Scale (DSSS) as the secondary outcome and the anxiosomatic cluster symptoms as rated by HDRS-17 as the post-hoc outcome were measured. Multivariable generalized estimating equation analysis was performed. Although no differences in overall HDRS-17 changes between three groups were found, the antidepressant efficacy based on DSSS was higher in piTBS than in iTBS and sham at week 3 (group effect,p = 0.003, post-hoc: piTBS > iTBS, p = 0.002; piTBS > sham, p = 0.038). In post-hoc analyses, piTBS had more alleviation in anxiosomatic symptoms than iTBS (group effect, p = 0.002; post-hoc, p = 0.001). This first randomized sham-controlled study directly compared piTBS and iTBS targeting the DMPFC using a figure-of-8 coil and found piTBS may fail to demonstrate a significant antidepressant effect on overall depressive symptoms, but piTBS seems superior in alleviating anxiosomatic symptoms, even in depressed patients with high treatment resistance. This Trial registration (Registration number: NCT04037592). URL: https://clinicaltrials.gov/ct2/show/NCT04037592 .
Collapse
Affiliation(s)
- Chih-Ming Cheng
- Institute of Brain Science, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Department of Psychiatry, Taipei Veterans General Hospital, Beitou District, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan
| | - Cheng-Ta Li
- Institute of Brain Science, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
- Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
- Department of Psychiatry, Taipei Veterans General Hospital, Beitou District, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan.
- Institute of Cognitive Neuroscience, National Central University, Jhongli, Taiwan.
| | - Jia-Shyun Jeng
- Department of Psychiatry, Taipei Veterans General Hospital, Beitou District, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Pingtung Branch, Pingtung, Taiwan
| | - Wen-Han Chang
- Department of Psychiatry, Taipei Veterans General Hospital, Beitou District, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan
- Graduate Institute of Statistics National Central University, Taoyuan, Taiwan
| | - Wei-Chen Lin
- Institute of Brain Science, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Department of Psychiatry, Taipei Veterans General Hospital, Beitou District, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan
| | - Mu-Hong Chen
- Institute of Brain Science, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Department of Psychiatry, Taipei Veterans General Hospital, Beitou District, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan
| | - Ya-Mei Bai
- Institute of Brain Science, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Department of Psychiatry, Taipei Veterans General Hospital, Beitou District, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan
| | - Shih-Jen Tsai
- Institute of Brain Science, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Department of Psychiatry, Taipei Veterans General Hospital, Beitou District, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan
| | - Tung-Ping Su
- Institute of Brain Science, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Department of Psychiatry, Taipei Veterans General Hospital, Beitou District, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan
- Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
| |
Collapse
|
8
|
Cortese S, McGinn K, Højlund M, Apter A, Arango C, Baeza I, Banaschewski T, Buitelaar J, Castro-Fornieles J, Coghill D, Cohen D, Grünblatt E, Hoekstra PJ, James A, Jeppesen P, Nagy P, Pagsberg AK, Parellada M, Persico AM, Purper-Ouakil D, Roessner V, Santosh P, Simonoff E, Stevanovic D, Stringaris A, Vitiello B, Walitza S, Weizman A, Wohlfarth T, Wong ICK, Zalsman G, Zuddas A, Moreno C, Solmi M, Correll CU. The Future of Child and Adolescent Clinical Psychopharmacology: A Systematic Review of Phase 2, 3, or 4 Randomized Controlled Trials of Pharmacologic Agents Without Regulatory Approval or for Unapproved Indications. Neurosci Biobehav Rev 2023; 149:105149. [PMID: 37001575 DOI: 10.1016/j.neubiorev.2023.105149] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
We aimed to identify promising novel medications for child and adolescent mental health problems. We systematically searched https://clinicaltrials.gov/ and https://www.clinicaltrialsregister.eu/ (from 01/01/2010-08/23/2022) for phase 2 or 3 randomized controlled trials (RCTs) of medications without regulatory approval in the US, Europe or Asia, including also RCTs of dietary interventions/probiotics. Additionally, we searched phase 4 RCTs of agents targeting unlicensed indications for children/adolescents with mental health disorders. We retrieved 234 ongoing or completed RCTs, including 26 (11%) with positive findings on ≥ 1 primary outcome, 43 (18%) with negative/unavailable results on every primary outcome, and 165 (70%) without publicly available statistical results. The only two compounds with evidence of significant effects that were replicated in ≥ 1 additional RCT without any negative RCTs were dasotraline for attention-deficit/hyperactivity disorder, and carbetocin for hyperphagia in Prader-Willi syndrome. Among other strategies, targeting specific symptom dimensions in samples stratified based on clinical characteristics or established biomarkers may increase chances of success in future development programmes.
Collapse
|
9
|
Elbau IG, Lynch CJ, Downar J, Vila-Rodriguez F, Power JD, Solomonov N, Daskalakis ZJ, Blumberger DM, Liston C. Functional Connectivity Mapping for rTMS Target Selection in Depression. Am J Psychiatry 2023; 180:230-240. [PMID: 36855880 DOI: 10.1176/appi.ajp.20220306] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Repetitive transcranial magnetic stimulation (rTMS) protocols increasingly use subgenual anterior cingulate cortex (sgACC) functional connectivity to individualize treatment targets. However, the efficacy of this approach is unclear, with conflicting findings and varying effect sizes across studies. Here, the authors investigated the effect of the stimulation site's functional connectivity with the sgACC (sgACC-StimFC) on treatment outcome to rTMS in 295 patients with major depression. METHODS The reliability and accuracy of estimating sgACC functional connectivity were validated with data from individuals who underwent extensive functional MRI testing. Electric field modeling was used to analyze associations between sgACC-StimFC and clinical improvement using standardized assessments and to evaluate sources of heterogeneity. RESULTS An imputation-based method provided reliable and accurate sgACC functional connectivity estimates. Treatment responses weakly but robustly correlated with sgACC-StimFC (r=-0.16), but only when the stimulated cortex was identified using electric field modeling. Surprisingly, this association was driven by patients with strong global signal fluctuations stemming from a specific periodic respiratory pattern (r=-0.49). CONCLUSIONS Functional connectivity between the sgACC and the stimulated cortex was correlated with individual differences in treatment outcomes, but the association was weaker than those observed in previous studies and was accentuated in a subgroup of patients with distinct, respiration-related signal patterns in their scans. These findings indicate that in a large representative sample of patients with major depressive disorder, individual differences in sgACC-StimFC explained only ∼3% of the variance in outcomes, which may limit the utility of existing sgACC-based targeting protocols. However, these data also provide strong evidence for a true-albeit small-effect and highlight opportunities for incorporating additional functional connectivity measures to generate models of rTMS response with enhanced predictive power.
Collapse
Affiliation(s)
- Immanuel G Elbau
- Department of Psychiatry and Brain and Mind Research Institute, Weill Cornell Medicine, New York (Elbau, Lynch, Power, Solomonov, Liston); Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, and Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Downar, Blumberger); Non-Invasive Neurostimulation Therapies Lab and Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez); Department of Psychiatry, University of California, San Diego (Daskalakis)
| | - Charles J Lynch
- Department of Psychiatry and Brain and Mind Research Institute, Weill Cornell Medicine, New York (Elbau, Lynch, Power, Solomonov, Liston); Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, and Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Downar, Blumberger); Non-Invasive Neurostimulation Therapies Lab and Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez); Department of Psychiatry, University of California, San Diego (Daskalakis)
| | - Jonathan Downar
- Department of Psychiatry and Brain and Mind Research Institute, Weill Cornell Medicine, New York (Elbau, Lynch, Power, Solomonov, Liston); Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, and Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Downar, Blumberger); Non-Invasive Neurostimulation Therapies Lab and Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez); Department of Psychiatry, University of California, San Diego (Daskalakis)
| | - Fidel Vila-Rodriguez
- Department of Psychiatry and Brain and Mind Research Institute, Weill Cornell Medicine, New York (Elbau, Lynch, Power, Solomonov, Liston); Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, and Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Downar, Blumberger); Non-Invasive Neurostimulation Therapies Lab and Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez); Department of Psychiatry, University of California, San Diego (Daskalakis)
| | - Jonathan D Power
- Department of Psychiatry and Brain and Mind Research Institute, Weill Cornell Medicine, New York (Elbau, Lynch, Power, Solomonov, Liston); Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, and Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Downar, Blumberger); Non-Invasive Neurostimulation Therapies Lab and Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez); Department of Psychiatry, University of California, San Diego (Daskalakis)
| | - Nili Solomonov
- Department of Psychiatry and Brain and Mind Research Institute, Weill Cornell Medicine, New York (Elbau, Lynch, Power, Solomonov, Liston); Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, and Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Downar, Blumberger); Non-Invasive Neurostimulation Therapies Lab and Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez); Department of Psychiatry, University of California, San Diego (Daskalakis)
| | - Zafiris J Daskalakis
- Department of Psychiatry and Brain and Mind Research Institute, Weill Cornell Medicine, New York (Elbau, Lynch, Power, Solomonov, Liston); Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, and Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Downar, Blumberger); Non-Invasive Neurostimulation Therapies Lab and Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez); Department of Psychiatry, University of California, San Diego (Daskalakis)
| | - Daniel M Blumberger
- Department of Psychiatry and Brain and Mind Research Institute, Weill Cornell Medicine, New York (Elbau, Lynch, Power, Solomonov, Liston); Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, and Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Downar, Blumberger); Non-Invasive Neurostimulation Therapies Lab and Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez); Department of Psychiatry, University of California, San Diego (Daskalakis)
| | - Conor Liston
- Department of Psychiatry and Brain and Mind Research Institute, Weill Cornell Medicine, New York (Elbau, Lynch, Power, Solomonov, Liston); Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, and Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Downar, Blumberger); Non-Invasive Neurostimulation Therapies Lab and Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez); Department of Psychiatry, University of California, San Diego (Daskalakis)
| |
Collapse
|
10
|
Jones MP, Holtmann G. Placebo effects in functional dyspepsia: Causes and implications for clinical trials. Neurogastroenterol Motil 2023; 35:e14527. [PMID: 36592054 PMCID: PMC10078415 DOI: 10.1111/nmo.14527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 01/03/2023]
Abstract
Placebo responses to an apparently inactive intervention are of interest from a scientific perspective as they suggest possible mechanism(s) at work beyond the intervention itself. They are also of interest from a clinical trials perspective since high rates of placebo response limit the potential to demonstrate worthwhile efficacy of a new intervention. This mini-review was motivated by the work of Bosman and colleagues(Neurogastroenterol Motil, 2022, and e14474) that is published in this issue of the journal in which they report on a systematic review and meta-analysis of placebo response in functional dyspepsia clinical trials. The review sets the scene for their work by putting it in the context of other disorders of brain-gut interaction and extra-gastrointestinal disorders. The review canvasses potential mechanisms of placebo response.
Collapse
Affiliation(s)
- Michael P Jones
- School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Gerald Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital and Translational Research Institute (TRI), Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|